A call came about noon a few years ago that a patient I'll call Stella was being admitted once again. She had come into the ER from her nursing home to receive transfusions. These were now needed every two weeks to keep her alive. The problem was that every time Stella was moved she decompensated. Her Alzheimer's was severe. She no longer recognized her family. She was now 83 and slowly ...

Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75: An argument that society and families -- and you -- will be better off if nature takes its course swiftly and promptly." As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest -- and that it ...

Brittany Maynard has passed from this life. This brave but unfortunate 29-year-old woman with incurable progressive brain cancer drew public attention by choosing to go public with her choice about end of life care.
"Brittany suffered increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms," according to a statement Sunday night from Sean Crowley, spokesman for Compassion & Choices, a national nonprofit working to expand end-of-life ...

Much is being made of the AMA's recommendation to reimburse doctors for the time they take in having end-of-life discussions with their patients. The recommendations appear to have a good chance of being covered by Medicare and certainly are a step in the right direction. But will one conversation and the completed documents really work? Well, like so many other situations -- it depends.
How skilled is the medical provider ...

I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient. That seemed self evident and logical. "Do no harm" was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make "the right" decision for them -- not necessarily including them in the conversation or ...

Agnes was out shopping at her local corner store. At age 82 her body was beginning to show typical signs of aging. She had survived breast cancer surgery, a hip replacement, and cataract surgery. Her doctors told her she had osteoporosis and low vitamin D. She took medications for her hypertension, cholesterol, and osteoporosis. Her spine had begun to curve and her gait was a few steps slower.
Yet, with her ...

Susan was 76 and dying at home in the days before hospice and before the use of the POLST form. A neighbor came in the relieve Susan's daughter who went to the store. Suddenly Susan stopped breathing and the neighbor called 911. The medics came and, not having instructions to the contrary, did CPR and brought her to our ER unconscious and intubated. The ER physician called me in the ...

When I was in medical school, our nutrition researchers taught us that vitamins didn't do much good and only made expensive urine (where the water soluble ones end up). We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc. But the evidence that healthy people should take vitamins was marginal at best.
Is our search for immortality the reason that we turn to the pill or potion? Do ...

"Hey doc, I saw on an ad on the TV last night about this new asthma inhaler. Shouldn't I give it a try?"
This type of question would occur several times a week. When I started practicing medicine it was considered unethical to advertise medical treatments. Now, we're bombarded with enticements for tests and treatments. The inhaler the patient requested cost $264 a month -- more than double what he was ...

Ben's first symptom was coughing up blood. The cancer had been silently growing for months, if not a few years. He had no pain or shortness of breath. The chest x-ray showed a "5cm L hilar mass" and the subsequent CT scan showed enlarged lymph nodes and likely spread to the liver.
"So Doc, what is it? A cancer? How much time do you give me?" All these questions on a ...